Pocono Medical Center's next health care expansion won't be built with glass and steel.

HOWARD FRANK

Pocono Medical Center's next health care expansion won't be built with glass and steel.

Instead, the medical center plans to shift its resources from treatment to prevention. It's a change in philosophy that addresses rising costs, lower insurance reimbursements and medical recidivism.

To get there, PMC will bring patient care closer to the communities it serves in both the physical and virtual worlds.

The idea is simple: Keeping people healthy is easier and less costly than treating illness.

The shift has already begun.

PMC is building "medical homes" in Bartonsville and Brodheadsville that bring family and specialty care closer to where people live. A third center, the Tobyhanna Medical Home, has been operating since 2012.

These centers combine several high-demand medical services and provide imaging and testing capabilities, making them mini-medical centers.

The hospital also built acute treatment facilities — urgent care centers around the county that often replace far costlier emergency room visits.

Providing care where people live has an impact on health. Convenience makes patients more likely to seek treatment, follow treatment plans and follow up with their specialists.

It addresses a big concern in medicine today. Call it medical recidivism: the likelihood of a disease reoccurring because patients didn't follow doctors' orders in the first place.

With local access to medical care, patients are more likely to keep follow-up appointments. That allows medical providers to monitor patients' treatments and progress.

The past decade saw major physical changes in the medical center building to keep up with the county's growing population and changing needs. But the building boom is just about done.

Maintaining health goes beyond brick-and-mortar structures.

"Care is moving out of the hospital into the community," said PMC President and CEO Kathleen Kuck.

And there's a sound financial reason for that. The federal government penalizes hospitals if its readmission rates are too high. The key, Kuck said, is to manage chronic disease.

There's another cost factor. It costs patients or their insurers thousands of dollars a day for in-hospital stays. Getting it right the first time saves many of these additional hospitalizations.

East Stroudsburg University conducted a health needs assessment for the hospital several years ago. The goal was to identify the health needs in the community.

Heart disease and cancer are by far Monroe County's leading causes of death. Every other disease drops off significantly. So the hospital built heart and cancer centers to address these needs.

The study also found that more young mothers weren't seeking prenatal care in the first trimester of their pregnancies. There were also more expectant mothers with drug problems. So the hospital built a neonatal intensive care unit to treat premature and ill newborns.

Other health issues identified in the study were obesity, alcohol use and behavioral health, according to Kuck.

PMC is training a group of volunteer East Stroudsburg University students to act as health coaches for these patients. Their goal? To curb readmissions.

"Half of all patients leave hospitals and doctors' offices without understanding the advice they were given," said PMC spokesman Geoffrey Roche.

The majority don't follow most of the instructions.

"For chronic illnesses, such as diabetes and heart disease, too often those patients quickly end up back in the hospital," he said.

The ESU students, many of whom are going onto health science careers, visit the patients in their homes to make sure they follow their doctor's instructions. That means monitoring their medications and making sure the patient is eating well. Sometimes they even go food shopping with the patients.

PMC has also worked with the Stroud Area Regional Police to train school resource officers to recognize signs of behavioral problems. That can lead to early intervention with school counselors and other professionals.

The resource officers, members of the SARP police force assigned to its local school districts, were chosen for training because of their daily contact with the students.

The hospital is building a web-based community health portal that focuses on population health. That looks at the composition of the community in several ways — demographically, geographically, behaviorally and environmentally — and then determine the services needed.

PMC intends to populate the site with every community resource, health-related or social service program along with information on each one. The goal is to use the portal to allow the community to search for services and request preferred times to visit.

It will also tell the hospital what services are sought the most.

"We will know how many times they'll be hitting that (service's) button," Kuck said.

That project is separate from the medical center's patient portal, where individuals can, through access to the Internet, manage their appointments, request prescription refills, see lab reports, view their health records and send messages to their physician. Anyone can sign up for the portal through their participating medical provider.

Kuck hopes it will reduce duplication of testing, part of the high cost of medical care today.

Kuck believes in the near future we will begin to examine medical decisions made for treatments at the end of a patient's life. These decisions often prolong life without quality.

"I think we need to educate people on what it is," she said. "We grew up with the do-all for everyone. Physicians were brought up that way. It's devastating for the doctor when a patient dies."

She hopes to educate families on how to arrive at the decision on what kinds of treatments are appropriate for someone with a terminal illness. And to teach people to have these conversation with their parents.

"They can design their health care directives to specify terminal irreversible illnesses decisions. Maybe physicians will have that conversation with their patients."

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